|
NEEDLE ANCHOR 1849D
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR 1849D
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963407
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR 3/8 CIRCLE REVERSE CUTTING 1822-12DC
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR 3/8 CIRCLE REVERSE CUTTING 1822-12DC
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963411
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR 842-20DC DISP
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2963503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
NEEDLE ANCHOR 842-20DC DISP
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2963503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$22.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.21
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.25
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$47.40
|
| Rate for Payer: The Alliance Commercial |
$316.00
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
NEEDLE ANCHOR CATGUT 1/2 CIRCLE SZ 6 1826-6DC
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR CATGUT 1/2 CIRCLE SZ 6 1826-6DC
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963409
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR DISPOSABLE 1825-4D
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR DISPOSABLE 1825-4D
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR DISP SIZE 5 1824-5DC
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR DISP SIZE 5 1824-5DC
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR TAPER 1/2 CIRCLE 1824-4DC
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2963298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANCHOR TAPER 1/2 CIRCLE 1824-4DC
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2963298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
NEEDLE ANESTHESIA REINFORCED 27GA X 3 1/2 IN RAN-027-5
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
5563484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$165.60
|
| Rate for Payer: Health EOS Commercial |
$160.20
|
| Rate for Payer: HFN Commercial |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: NAPHCARE Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$165.60
|
| Rate for Payer: Quartz Beloit One Network |
$88.20
|
| Rate for Payer: Quartz Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: WPS Commercial |
$133.33
|
|
|
NEEDLE ANESTHESIA REINFORCED 27GA X 3 1/2 IN RAN-027-5
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
5563484
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.80
|
| Rate for Payer: Aetna Managed Medicare |
$50.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$117.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$90.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$165.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.73
|
| Rate for Payer: Health EOS Commercial |
$160.20
|
| Rate for Payer: HFN Commercial |
$165.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: NAPHCARE Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$165.60
|
| Rate for Payer: Quartz Beloit One Network |
$88.20
|
| Rate for Payer: Quartz Commercial |
$117.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.00
|
| Rate for Payer: The Alliance Commercial |
$720.00
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: WPS Commercial |
$133.33
|
|
|
Needle Aspiration - Bronchoscopy Charge
|
Facility
|
IP
|
$5,361.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
2990187
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$2,626.89 |
| Max. Negotiated Rate |
$4,932.12 |
| Rate for Payer: Aetna Commercial |
$4,824.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,610.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,841.33
|
| Rate for Payer: Cash Price |
$1,608.30
|
| Rate for Payer: Cigna Commercial |
$4,932.12
|
| Rate for Payer: Health EOS Commercial |
$4,771.29
|
| Rate for Payer: HFN Commercial |
$4,932.12
|
| Rate for Payer: Multiplan Commercial |
$4,288.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,216.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,932.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,626.89
|
| Rate for Payer: Quartz Commercial |
$3,216.60
|
| Rate for Payer: WEA Trust Commercial |
$2,948.55
|
| Rate for Payer: WPS Commercial |
$3,970.89
|
|
|
Needle Aspiration - Bronchoscopy Charge
|
Facility
|
OP
|
$5,361.00
|
|
|
Service Code
|
CPT 31629
|
| Hospital Charge Code |
2990187
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$2,573.28 |
| Max. Negotiated Rate |
$13,769.28 |
| Rate for Payer: Aetna Commercial |
$4,824.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,610.46
|
| Rate for Payer: Aetna Managed Medicare |
$3,701.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,484.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,680.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,573.28
|
| Rate for Payer: Anthem Medicare Advantage |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,841.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,701.42
|
| Rate for Payer: Cash Price |
$1,608.30
|
| Rate for Payer: Cash Price |
$1,608.30
|
| Rate for Payer: Cigna Commercial |
$4,932.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,701.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,701.42
|
| Rate for Payer: Health EOS Commercial |
$4,771.29
|
| Rate for Payer: HFN Commercial |
$4,932.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,701.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,701.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,701.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,701.42
|
| Rate for Payer: Multiplan Commercial |
$4,288.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.13
|
| Rate for Payer: Preferred Network Access Commercial |
$4,932.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,626.89
|
| Rate for Payer: Quartz Commercial |
$3,484.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,701.42
|
| Rate for Payer: The Alliance Commercial |
$6,292.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,701.42
|
| Rate for Payer: United Healthcare PPO |
$4,020.75
|
| Rate for Payer: WEA Trust Commercial |
$2,948.55
|
| Rate for Payer: Wellcare Medicare |
$3,701.42
|
| Rate for Payer: WPS Commercial |
$3,970.89
|
|
|
NEEDLE BIOPSY CHEST LINING 32400
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
CPT 32400
|
| Hospital Charge Code |
3014413
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$990.85 |
| Rate for Payer: Aetna Commercial |
$990.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.98
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$990.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.80
|
| Rate for Payer: Health EOS Commercial |
$949.13
|
| Rate for Payer: HFN Commercial |
$990.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$286.07
|
| Rate for Payer: Multiplan Commercial |
$834.40
|
| Rate for Payer: Preferred Network Access Commercial |
$990.85
|
| Rate for Payer: Quartz Beloit One Network |
$458.92
|
| Rate for Payer: Quartz Commercial |
$594.51
|
| Rate for Payer: The Alliance Commercial |
$521.50
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
NEEDLE BIOPSY, LYMPH NODES 38505
|
Professional
|
Both
|
$1,048.00
|
|
|
Service Code
|
CPT 38505
|
| Hospital Charge Code |
3014582
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$995.60 |
| Rate for Payer: Aetna Commercial |
$995.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$901.28
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cash Price |
$314.40
|
| Rate for Payer: Cigna Commercial |
$995.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$628.80
|
| Rate for Payer: Health EOS Commercial |
$953.68
|
| Rate for Payer: HFN Commercial |
$995.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$233.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.76
|
| Rate for Payer: Multiplan Commercial |
$838.40
|
| Rate for Payer: Preferred Network Access Commercial |
$995.60
|
| Rate for Payer: Quartz Beloit One Network |
$461.12
|
| Rate for Payer: Quartz Commercial |
$597.36
|
| Rate for Payer: The Alliance Commercial |
$524.00
|
| Rate for Payer: United Healthcare Medicaid |
$136.08
|
| Rate for Payer: WEA Trust Commercial |
$576.40
|
| Rate for Payer: WPS Commercial |
$776.25
|
|
|
NEEDLE BIOPSY OF LIVER 47000
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
CPT 47000
|
| Hospital Charge Code |
3014853
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.28 |
| Max. Negotiated Rate |
$736.25 |
| Rate for Payer: Aetna Commercial |
$736.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$736.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.00
|
| Rate for Payer: Health EOS Commercial |
$705.25
|
| Rate for Payer: HFN Commercial |
$736.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$296.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$296.87
|
| Rate for Payer: Multiplan Commercial |
$620.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.25
|
| Rate for Payer: Quartz Beloit One Network |
$341.00
|
| Rate for Payer: Quartz Commercial |
$441.75
|
| Rate for Payer: The Alliance Commercial |
$387.50
|
| Rate for Payer: United Healthcare Medicaid |
$121.28
|
| Rate for Payer: WEA Trust Commercial |
$426.25
|
| Rate for Payer: WPS Commercial |
$574.04
|
|
|
Needle biopsy of Liver 47379-47000
|
Professional
|
Both
|
$631.00
|
|
|
Service Code
|
CPT 47379
|
| Hospital Charge Code |
5355250
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$277.64 |
| Max. Negotiated Rate |
$599.45 |
| Rate for Payer: Aetna Commercial |
$599.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.66
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cigna Commercial |
$599.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$315.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.60
|
| Rate for Payer: Health EOS Commercial |
$574.21
|
| Rate for Payer: HFN Commercial |
$599.45
|
| Rate for Payer: Multiplan Commercial |
$504.80
|
| Rate for Payer: Preferred Network Access Commercial |
$599.45
|
| Rate for Payer: Quartz Beloit One Network |
$277.64
|
| Rate for Payer: Quartz Commercial |
$359.67
|
| Rate for Payer: The Alliance Commercial |
$315.50
|
| Rate for Payer: WEA Trust Commercial |
$347.05
|
| Rate for Payer: WPS Commercial |
$467.38
|
|
|
NEEDLE BONE BIOPSY 13ga 10cm #DBBN-13-10.0-M2
|
Facility
|
OP
|
$877.00
|
|
| Hospital Charge Code |
2971722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.56 |
| Max. Negotiated Rate |
$3,508.00 |
| Rate for Payer: Aetna Commercial |
$789.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$754.22
|
| Rate for Payer: Aetna Managed Medicare |
$245.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$570.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$438.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.81
|
| Rate for Payer: Cash Price |
$263.10
|
| Rate for Payer: Cigna Commercial |
$806.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.77
|
| Rate for Payer: Health EOS Commercial |
$780.53
|
| Rate for Payer: HFN Commercial |
$806.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.75
|
| Rate for Payer: Multiplan Commercial |
$701.60
|
| Rate for Payer: NAPHCARE Commercial |
$526.20
|
| Rate for Payer: Preferred Network Access Commercial |
$806.84
|
| Rate for Payer: Quartz Beloit One Network |
$429.73
|
| Rate for Payer: Quartz Commercial |
$570.05
|
| Rate for Payer: Quartz Medicare Advantage |
$526.20
|
| Rate for Payer: The Alliance Commercial |
$3,508.00
|
| Rate for Payer: WEA Trust Commercial |
$482.35
|
| Rate for Payer: WPS Commercial |
$649.59
|
|
|
NEEDLE BONE BIOPSY 13ga 10cm #DBBN-13-10.0-M2
|
Facility
|
IP
|
$877.00
|
|
| Hospital Charge Code |
2971722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.73 |
| Max. Negotiated Rate |
$806.84 |
| Rate for Payer: Aetna Commercial |
$789.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$754.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.81
|
| Rate for Payer: Cash Price |
$263.10
|
| Rate for Payer: Cigna Commercial |
$806.84
|
| Rate for Payer: Health EOS Commercial |
$780.53
|
| Rate for Payer: HFN Commercial |
$806.84
|
| Rate for Payer: Multiplan Commercial |
$701.60
|
| Rate for Payer: NAPHCARE Commercial |
$526.20
|
| Rate for Payer: Preferred Network Access Commercial |
$806.84
|
| Rate for Payer: Quartz Beloit One Network |
$429.73
|
| Rate for Payer: Quartz Commercial |
$526.20
|
| Rate for Payer: WEA Trust Commercial |
$482.35
|
| Rate for Payer: WPS Commercial |
$649.59
|
|
|
NEEDLE BONE MARROW & ASPIRATION ILLINOIS 15GA DIN1515X
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
2963142
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.51 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.47
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$367.08
|
| Rate for Payer: Health EOS Commercial |
$355.11
|
| Rate for Payer: HFN Commercial |
$367.08
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: NAPHCARE Commercial |
$239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$367.08
|
| Rate for Payer: Quartz Beloit One Network |
$195.51
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
